Local Authority request for information from HMRC

To:

Details of claimant about whom information is requested

Surname: Forename(s): NINO: DOB: Home Address: Business Name: & Address

Details of third party about whom information is requested

Surname: Forename(s): NINO: DOB: Home Address: Business Name: & Address REQUEST FOR HMRC INFORMATION

Form RFI examined: □ OIU Reference:

Information requested: (Please note that the exchange of information is not mandatory. Only information that is proportionate to the nature of your enquiry will be provided.)

Reason for request: (State details of the investigation or enquiry to which the request relates. These details must show how the individual or company are linked to the enquiry and state what they are suspected of doing.)

Requesting Officer:

| Name | Tel No | |------|--------| | Dept | Fax no | | Address | Email |

Signature & Date:

This information is requested under:

☐ Section 121 and/or 122 of the Social Security Administration Act 1992

☐ Schedule 5 of the Tax Credits Act 2002

(Tick as appropriate)